PRC Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: Which autonomic nervous system finding suggests elevated sympathetic tone that may impair PRI intervention outcomes?
- Heart rate variability within normal limits at rest
- Persistently elevated resting heart rate with reduced heart rate variability (Correct answer)
- Slow and regular breathing rate at rest
- Normal pupillary light reflex bilaterally
Correct answer: Persistently elevated resting heart rate with reduced heart rate variability
Persistently elevated heart rate with reduced HRV indicates sympathetic dominance, which impairs the parasympathetic activation required for effective PRI repositioning.
Question 2: Which neurological sign warrants immediate referral before initiating PRI treatment?
- Decreased ankle dorsiflexion range of motion
- Progressive lower extremity weakness with bowel and bladder changes (Correct answer)
- Mildly reduced patellar deep tendon reflex
- Symmetric bilateral hip flexor tightness
Correct answer: Progressive lower extremity weakness with bowel and bladder changes
Progressive neurological deficits with bowel and bladder dysfunction suggest cauda equina syndrome, a surgical emergency requiring immediate referral.
Question 3: When assessing respiratory risk, which measurement indicates the highest risk for exercise-induced oxygen desaturation during PRI exercises?
- FEV1/FVC ratio of 0.80
- Resting SpO2 of 96%
- Resting SpO2 of 88% with documented COPD (Correct answer)
- Well-controlled mild asthma with rescue inhaler
Correct answer: Resting SpO2 of 88% with documented COPD
A resting SpO2 of 88% in a COPD patient indicates severely compromised respiratory reserve, making desaturation with any exertion highly probable.
Question 4: A patient with a documented left-on-left sacral torsion is referred for PRI assessment. What specific risk does this structural finding introduce?
- Increased likelihood of developing a right AIC pattern
- Difficulty achieving the left hip extension required for specific PRI exercises (Correct answer)
- Reduced risk of thoracic outlet syndrome
- Improved response to posterior mediastinal repositioning
Correct answer: Difficulty achieving the left hip extension required for specific PRI exercises
Left-on-left sacral torsion restricts the sacral mechanics needed for left hip extension, directly limiting performance of key PRI exercises.
Question 5: Which cervical screening finding most increases the risk of vertebrobasilar insufficiency during PRI cervical techniques?
- Mild cervical lordosis reduction
- Positive Hautant's test with cervical rotation (Correct answer)
- Forward head posture of 2 cm
- Cervical rotation limited to 60 degrees bilaterally
Correct answer: Positive Hautant's test with cervical rotation
A positive Hautant's test indicates vertebrobasilar compromise, contraindicating cervical rotation techniques that could further reduce vertebral artery flow.
Question 6: In PRI neurological risk assessment, persistent bilateral upper extremity paresthesia most suggests the need for which action before treatment?
- Proceed directly with standard PRI upper extremity exercises
- Rule out cervical myelopathy or bilateral thoracic outlet syndrome before treatment (Correct answer)
- Immediately increase respiratory exercise intensity
- Focus exclusively on lower extremity repositioning
Correct answer: Rule out cervical myelopathy or bilateral thoracic outlet syndrome before treatment
Bilateral upper extremity paresthesia may indicate cervical myelopathy or bilateral thoracic outlet syndrome, requiring diagnostic workup before PRI intervention is safe.
Question 7: Which patient presentation would most require a modified PRI approach due to neurological risk factors?
- A healthy 25-year-old athlete with postural asymmetry
- A 68-year-old with cervical stenosis and bilateral hand numbness (Correct answer)
- A distance runner with IT band syndrome and left AIC pattern
- A desk worker with a right-leaning thoracic posture
Correct answer: A 68-year-old with cervical stenosis and bilateral hand numbness
Cervical stenosis with bilateral hand numbness signals myelopathic risk, requiring modified head and neck positioning and avoidance of cervical loading techniques.
PRC Risk Assessment & Mitigation 3
Which autonomic nervous system finding suggests elevated sympathetic tone that may impair PRI intervention outcomes?